Degenerative disc disease occurs as part of the normal aging process and its treatment costs run in the many billions of dollars per year (Patil, 2005). Cervical spondylotic myelopathy (CSM) is the most debilitating form of degenerative disc disease, and is the most common acquired cause of spinal cord dysfunction in adults greater than 50 years of age (Wilkinson, 1960, Young et al, 2000). Although decompression surgery is frequently advocated for this condition, the neurological recovery and clinical response to operative intervention can be quite variable and inconsistent. The risks and possible complications of these procedures are not inconsequential. The fact that some patients do not notice improvement of neurological function following surgery, despite macroscopic imaging showing alleviation of the compression and re-expansion of the spinal cord, suggests there may be cellular mechanisms affecting outcome that are not manifested using standard MRI. MR spectroscopy (MRS) has become widely accepted as a method to provide pertinent information regarding cellular physiology and integrity in the central nervous system, and is commonly used as an adjunct to standard MR in the evaluation of neoplastic, inflammatory, and infectious disorders affecting the brain. Our laboratory has recently adapted this technology for spinal applications, and we were the first to describe its use in the evaluation of CSM (Holly, 2009). Due to the poor natural history of CSM, inherent risks of treatment, and individual/societal cost associated with this disorder, there is a distinct need to develop more accurate, noninvasive methods to predict lesion severity and potential for neurological recovery following operative intervention. Additionally, in those patients treated nonoperatively, the development of non-invasive modalities to monitor subclinical disease progression is of high priority. Our primary goals are to 1) confirm that the spinal cord NAA/Cr ratio is indeed decreased in CSM patients;2) to assess the utility of this neurochemical measurement as a biomarker to assay spinal cord viability and response to surgical treatment. If validated by the studies described in this proposal, these hypotheses will help further elucidate the cellular mechanisms involved both in the pathogenesis of chronic spinal cord injury, as well as neurological recovery. Furthermore this information may help define the appropriateness and timing of operative and nonoperative treatment for CSM patients. PUBLIC HEALTH RELEVANCE: Cervical spondylotic myelopathy (CSM) is a form of chronic spinal cord injury caused by degenerative spine disease, and is the most common acquired cause of spinal cord dysfunction in adults. The neurological recovery and clinical response from both surgical and nonsurgical treatment can be quite variable and inconsistent. Due to the poor natural history of CSM, inherent risks of treatment, and individual/societal cost associated with this disorder, there is a distinct need to develop more accurate, noninvasive methods to predict potential for neurological recovery following medical intervention. The proposed study will use MR Spectroscopy to evaluate the cellular spinal cord damage, and determine if this technique can be used to predict response to surgical and nonsurgical treatment.